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EMPLOYMENT APPLICATION AMC Systems, Inc.

AMC Systems is an equal opportunity employer and affords equal opportunity to all applicants for all positions without regard to race, color, religion, gender, national origin, age, disability, veteran status or any other status protected under local, state or federal laws.

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Position(s) Applied For Date of Application

Last Name First Name Middle Name

Address City State Zip Code Telephone Number Alternate Number Social Security Number (If available) How Did You Hear About Us? [] Newspaper Ad [] Employment Agency [] Current Employee ______[] Other ______Are you legally eligible to work in the United States? YES [] NO [] (Proof of eligibility will be required upon offer of employment) Are you over the age of 18 years? YES [] NO [] (If no, you may be required to provide authorization) Can you with or without reasonable accommodation perform the essential functions of this job? (If you have any questions about the functions of the job, please ask the interviewer before YES [] NO [] answering this question.) Have you ever applied to AMC Systems before? (If yes, please give date.) ______YES [] NO [] Have you ever worked for AMC Systems before? (If yes, please give date.) ______YES [] NO [] Have you ever been convicted of a felony? YES [] NO [] If yes, please explain: ______Do you have a valid driver's license?(For driving positions only.) YES [] NO [] Have you been convicted of any moving violations in the past five years? YES [] NO [] If yes, please explain: ______Is anyone related to you employed by AMC? YES [] NO [] If yes, please give their name and relationship to you. ______What salary or rate of pay do you expect to receive if employed? ______per _____ Have you ever been fired or asked to resign from a job? YES [] NO [] If yes, please explain.______On what date would you be available to work? ______

EDUCATION Name and Location Course of Study # of Years Diploma/

of School or Major Completed Degree High School College Graduate Vocational

Describe any specialized training, apprenticeships, licenses or skills. Have you received any job-related training in the United States Military? YES [] NO [] Please give dates and explanation:

EMPLOYMENT HISTORY (Begin with current or most recent employer. Do not exclude any employment. Include any applicable temporary employment attach another sheet if necessary. Previous salaries or wages will not be used to determine compensation at AMC.)

Salary Company Name Employment Dates Start End From To Name and Title of Supervisor

Address $ $ Describe your duties: Phone Reason for leaving and explanation

Please provide any other information that you feel will help us in considering your application for employment.

REFERENCES (Please list three persons, who are not related to you or previous supervisors, who can provide professional references.) Name Phone Number Relationship/Occupation Years Known

APPLICANT ACKNOWLEDGEMENT AND AUTHORIZATION

*PLEASE READ CAREFULLY BEFORE SIGNING*

I hereby certify that all of the information provided by me in this application (or any other accompanying or required documents) is correct, accurate and complete to the best of my knowledge. I understand that the falsification, misrepresentation or omission of any facts in said documents will be cause for denial of employment or immediate termination of employment regardless of the timing or circumstances of discovery.

I understand that submission of an application does not guarantee employment. I further understand that, should an offer of employment be extended by AMC Systems (hereinafter referred to as "AMC") that such employment with AMC is at will, for no specified duration and may be terminated by either AMC or myself at any time, with or without cause or notice. I understand that none of the documents, policies, procedures, actions, statements of AMC or its representatives used during the employment process is deemed a contract of employment real or implied. I understand that no representative of AMC except the President has the authority to enter into any agreement guaranteeing any conditions of employment or any agreement contrary to the foregoing statements and that any such agreements must be made in writing and signed by the President of AMC.

In consideration for employment with AMC, if employed, I agree to conform to the rules, regulations, policies and procedures of AMC at all times and understand that such obedience is a condition of employment. I understand that due to the nature of AMC business, attendance and punctuality are considered essential requirements of every job at AMC and that poor attendance or tardiness will result in disciplinary action.

I herby authorize any and all schools, former employers, references, courts and any others who have information about me to provide such information to AMC and/or any of its representatives, agents or vendors and I release all parties involved from any and all liability for any and all damage that may result from providing such information.

I understand that this application is considered current for three months. If I wish to be considered for employment after this period I must fill out and submit a new application.

BY SIGNING BELOW I ACKNOWLEDGE THAT I HAVE READ, UNDERSTOOD AND AGREE TO THE ABOVE STATEMENTS.

______Signature Date

Name and number of person completing this form if other than applicant: ______

AMC IS PROUD TO BE AN EQUAL OPPORTUNITY EMPLOYER. ALL QUALIFIED APPLICANTS WILL RECEIVE CONSIDERATION WITHOUT REGARD TO RACE, COLOR, RELIGION, GENDER, NATIONAL ORIGIN, AGE, DISABILITY, VETERAN STATUS OR ANY OTHER STATUS PROTECTED BY LAW.